title: Risk factors for measles mortality among hospitalized Somali refugees displaced by famine, Kenya, 2011.
abstract: BACKGROUND
  Measles among displaced, malnourished populations can result in a high case fatality ratio. In 2011, a large measles outbreak occurred in Dadaab, Kenya, among refugees fleeing famine and conflict in Somalia. The aim of this study was to identify predictors of measles deaths among hospitalized patients during the outbreak.
  
  
  METHODS
  A retrospective cohort study design was used to investigate measles mortality among hospitalized measles patients with a date of rash onset during 6 June-10 September 2011. Data were abstracted from medical records and a measles case was defined as an illness with fever, maculopapular rash, and either cough, coryza or conjunctivitis. Vaccination status was determined by patient or parental recall. Independent predictors of mortality were identified using logistic regression analysis.
  
  
  RESULTS
  Of 388 hospitalized measles patients, 188 (49%) were from hospital X, 70 (18%) from hospital Y, and 130 (34%) from hospital Z; median age was 22 years, 192 (50%) were 15-29 years of age, and 22 (6%) were vaccinated. The mean number of days from rash onset to hospitalization varied by hospital (hospital X = 5, hospital Y = 3, hospital Z = 6; P < .0001). Independent risk factors for measles mortality were neurological complications (odds ratio [OR], 12.8; 95% confidence interval [CI], 3.1-52.4), acute malnutrition (OR, 7.6; 95% CI, 1.3-44.3), and admission to hospital Z (OR, 4.2; 95% CI, 1.3-13.2).
  
  
  CONCLUSIONS
  Among Somali refugees, in addition to timely vaccination at border crossing points, early detection and treatment of acute malnutrition and proper management of measles cases may reduce measles mortality.
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Abdirahman
authors.initials: A
authors.lastname: Mahamud
authors.forename: Ann
authors.initials: A
authors.lastname: Burton
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hassan
authors.forename: Jamal A
authors.initials: JA
authors.lastname: Ahmed
authors.forename: John B
authors.initials: JB
authors.lastname: Wagacha
authors.forename: Paul
authors.initials: P
authors.lastname: Spiegel
authors.forename: Chris
authors.initials: C
authors.lastname: Haskew
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Eidex
authors.forename: Sharmila
authors.initials: S
authors.lastname: Shetty
authors.forename: Susan
authors.initials: S
authors.lastname: Cookson
authors.forename: Carlos
authors.initials: C
authors.lastname: Navarro-Colorado
authors.forename: James L
authors.initials: JL
authors.lastname: Goodson
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008457:Measles / Q000453:epidemiology / Q000401:mortality*; D008458:Measles Vaccine; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012998:Somalia / Q000208:ethnology; D013217:Starvation / Q000453:epidemiology*; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D008458:Measles Vaccine
keywords: acute malnutrition; measles; mortality; refugees; vaccination